The hawk-i Program

The hawk-i program is part of Iowa’s State Child Health Insurance Program (also known as SCHIP or Title XXI), which is designed to provide health insurance coverage for uninsured children in Iowa up to 200 percent of the poverty level. The Iowa legislature authorized the creation of a two-part ‘combination’ SCHIP program (see Figure 1). The first part is a Medicaid expansion (M-SCHIP) for children with family incomes up to 133 percent of the federal poverty level (FPL). The second component is hawk-i, the separate state child health insurance program (S-SCHIP). hawk-i provides health insurance for children with family incomes from 134 to 200 percent of the FPL (the upper eligibility limit was raised from 185% to 200% of the FPL on July 1, 2000). In this program, the State of Iowa contracts with private health plans to provide covered services to enrolled children in the program. In hawk-i, families with incomes from 134 to 150 percent of the FPL have no premiums or copayments, while those with household incomes from 151 to 200 percent of the FPL pay a premium of $10 per child per month up to a maximum of $20 per family per month. For those above 150 percent of the FPL, there is also a $25 fee for non-emergent care provided in an emergency room (non-emergent is defined following the prudent layperson standard). The first recipients were enrolled in hawk-i in January 1999. As of November 1, 2002, there were 12,031 children enrolled in the Medicaid expansion program and 13,845 children enrolled in hawk-i.

Figure 1. Iowa's State Child Health Insurance Programs

John Deere Health Plan and/or Iowa Health Solutions Health Plan are available to enrollees in 37 Iowa counties (see Figure 2). These are the counties in which the health plans contracted to provide services and had adequate provider networks. In all other counties, an indemnity health plan, Wellmark Blue Cross Blue Shield of Iowa, is available. John Deere Health Plan and Iowa Health Solutions are managed care plans. This means that hawk-i enrollees must use providers that participate with these plans, and that prior approval may be required before seeing certain providers. In Wellmark Blue Cross Blue Shield of Iowa, hawk-i enrollees may go to any provider who accepts Wellmark Blue Cross Blue Shield of Iowa insurance. All three health plans provide the same type of benefits, but they may have different utilization management processes, such as having a formulary for coverage of prescription drugs and limiting benefits to manage costs. UnityChoice, a managed care plan operating in some Iowa counties, stopped operating as a hawk-i managed care plan in July 2001. Results for UnityChoice enrollees are included in the total responses in this report, but are not included in the breakdown by health plan since they are no longer a participating health plan.

Figure 2. hawk-i Health Plans by County